This article was written by The Joint Commission and published in The Source April 2022 issue. You can read the original content here.
Patient education is fundamental to healthcare in any setting, but it is particularly important for ambulatory surgery centers (ASCs) because patients recover at home. Patients experience better outcomes when they receive high-quality education about their surgery and what to expect before, during, and after surgery. This concept is at the core of the Oregon Surgical Institute (OSI)’s total joint program and is a core requirement for organizations certified under The Joint Commission’s Advanced Total Hip and Total Knee Replacement (THKR) Certification Program (see standards
box on page 5).
Based in Beaverton, Oregon, OSI opened in 2018 and achieved The Joint Commission’s Advanced THKR certification in April 2021. The organization’s 10 total joint replacement surgeons performed nearly 1,000 total hip and knee replacement surgeries in OSI’s three operating rooms in 2021; OSI has plans to expand to five operating rooms in the near future. OSI also offers services in cardiac, gynecological, orthopedic trauma, sports medicine, and spine care. This article describes OSI’s patient education program for total joint care, including the team that implements the program, the program’s primary components, and how those components are continuously evaluated for patients’ needs and improvements in quality.
Assembling the Team
Patient education was OSI’s focus from the beginning. Even before construction on the facility was completed, OSI began gathering its team and designing a patient education program. “The push for patient education really came from our surgeons,” says Erin McKay, administrator at OSI. “They recognized this as the most important thing we could do for our patients to improve their outcomes.”
Surgeons are just one part of the patient education team at OSI. In addition, OSI has a full-time physical therapist on staff, who provides each total joint patient with postoperative physical therapy services on site, prior to discharge. Administration, nursing, and other clinical staff all share a strong commitment to ensuring that patients and their families receive the education they need to recover safely and
successfully after they leave the facility.
But the central figures in OSI’s total joint program are the orthopedic coordinators. These individuals are directly responsible for all total joint patient education and began actively building and refining the education program before OSI opened its doors. OSI currently has four full-time orthopedic coordinators. These nurses each have more than 10 years’ experience in orthopedic nursing with backgrounds as
total joint coordinators in hospitals.
The role of the orthopedic coordinators goes beyond creating educational materials. All total joint patients are shepherded by an orthopedic coordinator through their care experience. The patient can contact any orthopedic coordinator with questions or concerns at any time pre- or postoperatively. Similarly, the orthopedic coordinator can contact the patient to provide information and follow-up.
“This one-on-one attention is incredibly impactful for patients going through joint replacement surgery,” says Julie Carrick, one of OSI’s orthopedic coordinators. “They feel they have a nurse guiding them, answering their questions, and cheering them on.”
McKay explains that the orthopedic coordinators provide a type of “concierge medicine” experience for total joint patients. Their relationship with patients, developed through ongoing one-on-one time and open communication channels, leads to greater patient satisfaction and, by extension, better outcomes overall.
“Nurses are certainly capable of providing education at the bedside,” McKay emphasizes. “But we have found that the individual attention orthopedic coordinators provide makes patients feel special. They feel they matter. This is a huge factor in patient satisfaction.”
OSI believes that patient outcomes improve when orthopedic coordinators are involved. This is in part because well-educated patients are more likely to follow clinical instruction and successfully participate in their preparation and recovery
from surgery. But it also leads to shortened discharge times without compromising safety. The use of orthopedic coordinators leads to fewer hospitalizations following surgery, too, because patients are well-prepared to manage their care on their own, or with the help of family or friends.
“If you want to have a good program, you absolutely have to have orthopedic coordinators,” McKay says. “What they do is unparalleled. They are the people who have knowledge, compassion, commitment to shepherd any patient successfully through their experience with the total joint program.”
Integrating Education Throughout the Process
Orthopedic coordinators at OSI develop, refine, and use many tools to give patients the information they need in a way they can understand it. The goal is to make the process as smooth as possible. Patient education begins in the physician’s office and continues with multiple touchpoints leading to the day of surgery and extending to postoperative care. The following are among the program’s components:
Designated caregiver (coach). This individual, chosen by the patient, plays a critical role in a successful ambulatory total joint program. To qualify for outpatient total joint replacement surgery, the patient must have someone who can provide day-of and postdischarge care and support. The orthopedic coordinator engages coaches as much as possible to ensure that they, too, are prepared and have their questions answered. Coaches are encouraged to participate in all preoperative education and receive full postdischarge instructions to help them care for the patient outside the clinical setting. Coaches also observe the patient’s postoperative session with the physical therapist so they can assist the patient at home.
Patient app. A custom-designed application tool serves as an educational resource as well as a portal for communication among the patient, coach, orthopedic coordinator, surgeon, and other OSI team members. The app provides the patient with checklists, reminders, and “bite-sized” chunks of information crafted to be easy to understand and remember. “Patients and their coaches receive a lot of educational materials,” Carrick says. “The app breaks it down so they don’t get overwhelmed.” Preoperative education classes. Patients and coaches meet with the orthopedic coordinator before surgery to receive information and get questions asked and answered. The orthopedic coordinator provides a rough time line of surgery day, explains what the patient will do and when, gives instructions for preparation, and generally describes what the patient can expect at every step of the process. Information is both verbal and in writing to facilitate understanding and retention. These sessions are in person whenever possible. However, COVID-19 pandemic precautions required remote video classes. OSI plans to return to in-person classes as soon as it is safe to do so.
Discharge video. Orthopedic coordinators at OSI created an educational video for coaches to watch before discharge. (Patients are also encouraged to watch the video, though this takes place before surgery.) The video explains all discharge instructions in simple, easy-to-understand language to avoid overwhelming the coach. The information is also provided in written form and reviewed with the orthopedic coordinator before discharge.
Postoperative care plan. As part of the postoperative care plan, OSI helps patients connect with home health care and/or ongoing physical therapy services. The coach also receives a medication log for the patient. The log documents the medications provided during the patient’s time at OSI, describes medications the patient will be taking home, and provides medication management information (dosage, frequency, possible side effects, and so on). After discharge, the orthopedic coordinator maintains communication through the patient app and by phone. The coordinator checks in with patients about their progress through recovery. It is another opportunity for questions to be asked and answered about medications, physical therapy, restrictions, or other issues.
Continuous Improvement
The patient education program at OSI is continuously undergoing refinements to make the patient’s experience safer, improve satisfaction, and improve care outcomes. To do this, OSI relies on feedback from patients, coaches, surgeons, orthopedic coordinators, and other stakeholders. The patient app is one vehicle for collecting feedback from patients and coaches; patient satisfaction surveys are another.
One example of how feedback has improved patient education is a redesigned OSI website. “It was pretty basic,” McKay says. “It didn’t reflect the uniqueness of our program or serve our patients’ needs.” OSI revamped its website and incorporated suggestions from patients and staff. The website now serves as a resource for educational materials related to OSI’s total joint program. Patients can read stories about other OSI patients, communicate with their orthopedic coordinator, schedule remote preoperative classes, and download all paperwork and information.
At OSI, problems or suggestions for improvement are discussed at quarterly meetings, which are attended by surgeons, orthopedic coordinators, nurses, administrators, and others. These meetings highlight the team’s shared commitment to improvement, collaboration, and communication. Although it’s not always easy to get everyone on the same page, McKay says, all are committed to working things out. “People stay at these meetings until issues are resolved,” she says. Carrick echoes the sentiment. “Everyone’s voice is heard,” she explains. “No one is ever afraid they will get shut down. And that makes all the difference in the world.”
